My mother was on a Medicaid program for Community Attendant Services with DADS in the state of Texas for 7 years until she passed in November 2021. My father submitted all answers and sent documentation to HMS proving that there IS a surviving spouse (my father) and an older adult child (my sister) living in the home, yet my father recieved a letter telling him that due to there NOT being a surviving spouse (ironically the letter was sent to him) the claim will be monetary and billed $137,000. How could they ignore him being the surviving spouse even with proof he is very much alive and living in the home? (He is NOT a Medicaid recipient) Plus, he is co-owner of the homestead and recognized as such on the deed alongside my mother's name. Could they still pursue a claim against the home or force him to pay the 137k further down the road?
It is mind boggling the shear incompetence something like this takes. I am always soooo happy to pay my taxes when I read this kind of stuff.;-(
Hi! I don’t see how they could. Their claim is based on the wrong assumption that there is no surving spouse.
You probably need to go through the chain at the Medicaid office first since a collection agency probably only has information on the amount owed and not all the details.
We owed a hospital because of a mistake made when insurance was filed. It took going up several levels of the chain to get to someone who had security access in the computer to even see the information containing the error... no one else could see it. In our case it was 16 consecutive days of the same therapy yet two random days in the middle were not covered. (I could understand if it was the first two days or the last two days.) Finally someone higher up had access to see the original coding and saw that those two days had the wrong code! Everyone lower was simply basing their info on what they saw with their access level in their computer. I kept insisting on seeing who was next in line and was referred without making appointments, going office to office as necessary and even to another building across town! After seeing several people on the same day, my problem was solved and I owed nothing.
It can save you months of agony waiting for answers or being on hold waiting for the next person. When you know you are right... definitely go in person! When a person SEES the agony in your face, most will have a bit more human compassion and are more interested in helping you. All it may take is one sympathetic overworked government worker and they may help you get to the bottom of the problem. The computer is spitting out the bills based on what a human entered long ago!
The worst case scenario I "think" is a lien is put on the house. When I worked in Medicaid Third Party Liability in our state they could only ask for the amount they had spent and collect no more than a person assets. It is possible, they may only collect your mother's portion of the house when it is sold if your father never needs Medicaid and may need to wait until your father has died. The main thing to remember, no matter what you are told here, Medicaid has state specific laws.
It really is very easily done, you know - ask a civil servant to deviate from a straight line and his/her head will explode. I have two guesses, the first being that someone's eyes went straight to "adult child" and overlooked or anyway ballsed-up logging the more important surviving spouse; and the other [whisper it] is the possibility that your Dad did not correctly fill in question 433.2 of 549.
I know of a young man who confidently told a university admissions service that he did have a criminal record. He meant, of course, that he did not have a criminal record.
I also know of an older man who sent in his divorce application and was annoyed not to have heard anything at all back from the court after several months. It transpired that he had omitted to give his name and address on Page 1.
Anyhoooo - so unless you have already challenged this claim and met with further opposition, I should just go a-hunting to track down the hitch. It will be interesting to see which particular bug in the system emerges as the culprit.
not the State but HMS, amirite?
I would also think that the last letter he got (ignoring the fact he is alive) would have some sort of appeal process mentioned. You might want to contact any phone number involved in appeal as well.
I'm more inclined to believe it was an error.
I would call the County office and see if they can help with an appeal. Because that is what will need to be done an appeal. Maybe review Dads answers he sent to recovery.
When Mom went in, did Dad have their assets split by a lawyer? Moms half going to her her care and then applied for Medicaid? How did Dad answer questions on the recovery form? I hope a copy was kept.
An error has been made and you need to fight it.
I'd call the place first to not only make sure they received documentation [we don't know what was sent] but to see what they needed to prove relationship [send by certified mail]. IF that doesn't work talk with local Dept. of Aging which should be able to provide some guidance. As mentioned by someone else, there should be some type of process of appeal. Also, I presume you have something showing her account number, make sure they have the right one on your letter
I’m pretty sure that if an individual is on LTC Medicaid and is in a state that state law allows for this type of Tefra lien placement, the State can place a lien proactively on the property. The issue then becomes that this type of lien is rather subterranean to find… it can’t be quantified to be a set amount (like a mortgage or HELOC) as each day the elder has yet another room&board day rate placed on their LTC Medicaid enrollment. And they could get better and disenroll from Medicaid so lien stops. Because of stuff like this, it doesn’t show up necessarily as a courthouse filing onto the property. It is not like 400K mortgage which is filed at courthouse & till that mortgage is paid in full does that lien get a Release of a Deed of Trust filed. More a title search issue imo.
What has happened for Estate Recovery aka MERP is abt half of the States use an outside contractor. Two big ones are PCG & HMS. ((HMS is a very sophisticated company that also has a division that does compliance related issues for federal CMS (Centers for MediCARE & Medicaid) as it relates to Stark Law)). Both PCG & HMS send out letters with some sort of State seal or State Dept of Aging / Health letterhead on the HMS correspondence but denote that they are a contractor for the State. The contractors are not state employees. Some states have contractors attempting recovery overall and other states have it that State AG office does recovery for elders that die leaving a life insurance policy or annuity or other tort type of settlement with their Estate as beneficiary but contractors deal with the rest.
MERP contractors imo run paperwork like debt collectors do but are NOT under any federally mandated consumer protect laws like a regular debt collection co would be. They get paid for recovery process by the State AND get a % of recoup. There isn’t a well defined appeals process for estate recovery as there is for being found ineligible for Medicaid. Elder is dead, there isn’t an individual who an file an appeal per se as person on Medicaid & whom debt is placed is dead. It’s all assets / claims of an Estate now. IMO this a very important point….more below.
Figure sent out as supposed debt for those on LTC NH Medicaid is based on # of days elder was in a facility. Each state has preset room&board reimbursement rate that Medicaid pays a NH. So if $195 day R&B and in NH on LTC Medicaid 2 years, tally would be 730 days X 195 = $ 142,350.00. So $ 142,350K that State or the outside contractor attempts to get a recovery from the now deceased elders Estate. Can be way more than assets of an Estate are worth; if that happens, family/ heirs are not responsible for the remainder. If assets are more than what the supposedly tally is, then State gets paid & rest goes to heirs as per elders will. Again imo this part is very important
To me, why these things are mucho importante as in order to deal with MERP, opening probate may need to be done. By having probate open, having a will entered, Executor named, Letters Testamentary issued, etc. is there any formal legal way to deal on a more even playing field against an outside contractor should something go amiss.
if elder had a Trust, a Trust continues to exist; doesn’t matter who died. Trust keeps on trucking….
If elder had assets that in theory pass outside of probate - like Lady Bird Deed - those still will need legal paperwork filings at courthouse.
A lot of states have it so that if a person dies and no will is filed, so no probate is opened, then deceased have their assets “escheated” to the State.
If it “escheats” that means it is the State that now is in charge of the disposition of the estates assets as no heirs with legal standing have come forward. It’s a cumbersome process for a state to deal with; plus there’s the city / county tax assessor issues atop this. Imo it’s why you often see neglected & abandoned homes.
The elder is dead. There is no elder to represent.
Things go now into your states probate laws, heirship determinations, how assets of vs claims against an Estate are done, how real property transfers can be done, how an estates distribution(s) can be done.
IMO if the elder law atty isn’t experienced in probate and Medicaids estate recovery process, mistakes are going to happen. If your county does online portal system for probate documents entry, the atty needs to be recognized by probate court. An attorney who strictly does elder law work and estate planning might never do any probate work, so they cannot use the portal, may not have the document formats that tend to be some kinda precise for probate. Really if atty not experienced as to probate work, mistakes will happen.
Did your dad make & keep a copy of the HMS NOI? Did he send it certified & has USPS receipt showing it got sent up to Irving? I’m going to guess he didn’t… don’t fret this but he needs to a letter done ASAP.
The NOI is a Notice of Intent and it had a tight time frame to be filled out and returned. Please look at the letter date and the postmarked date…. If there is a difference between them be sure to mention this in his letter. fwiw I’ve had discrepancy dates of several days…. And it makes a huge difference as to required submission date. Back to you dad, if he submitted late, based on thier earliest date even if before mailing, the standard seems to be that the contractor assumes everything in NOI is accurate; no heirs or spouse, no exclusions, so basically case closed. NOI is a multi page questionnaire and within in there is a section as to if probate is anticipated to be opened and if there are anticipated exclusions and or exemptions to recovery that will be filed. It could be he didn’t put an answer in the right section or left something blank; or they totally overlooked his answer.
Going into a blame game isn’t helpful…
Before you go into more panic and try to find an probate attorney, I’d suggest that Dad sends up a friendly certified letter and with the return registered receipt card from the post office (you do this for him, but it’s as if he’s doing it) that “I’m in receipt of the denial letter, I believe there has been an oversight in the federally and state required review of the exemptions and exclusions to MERP; namely I am the surviving spouse. Attached is a xerox of our marriage license and also the most current tax collector statement that shows joint ownership of the property in both my name and my late wife’s name; As such I am entitled to whatever exemptions and or exclusions to MERP the State of TX has given to all surviving spouses; Thank you for your prompt action to this”. Remember to attach a copy of the denial letter, property tax bill and marriage license. Sending it with the green RRR post card, beyond mucho importante as dad will get this back with a signature and date on it from MERP. It’s legal and establishes they have it. Once he gets back the green postcard, then he (or you if you are his POA) can start calling HMS up by Dallas and then sending another USPS round of the same letter but this time dad mentions (and attaches a xerox of the signed green card) that they are in receipt of past letter and you want a 30 day resolution of the issue or probate will be opened. TX law allows for 4 years for probate to be opened. Saying that if need be probate will be opened implies that y’all will challenge all this should it be necessary
Try this and see what happens. Good luck.
a ? for you, if you don’t mind sharing, on your sister, is she herself trying to get exclusions or exemptions? If so, under which category (or categories)?